Quality versus Quantity
*The Healthcare Sterile Processing Association (HSPA) states in the (CHL) certification for healthcare leadership course that “a leader should focus on quality rather than quantity.”**According to an article written by Weston “Hank” Balch in Association of periOperative Registered Nurse in 2019, there are many benchmarks when considering productivity. Some of these are total cycle times, unprocessed trays at 7 a.m., missing instruments and incomplete trays, request and delivery times, and customer satisfaction. Balch states the total cycle can be determined when items are scanned electronically and that “this measurement also captures the speed of your manual cleaning, inspection, and assembly process to give you a good sense of the true speed of flow through your department.”
Many approaches determine leaders’ expectations for technicians to produce a certain number of trays in an eight-hour shift. If the number is established as a one-and-done concept for the whole department, the success of productivity expectations may be unattainable. Leaders should consider factors such as priority tray delegation, communication with the OR, access to the OR schedule, levels of experience per technician, and quality assurance steps in assembly.
A leader should first determine the end goal of productivity and define the best-case scenario for their projected results. The department's building process and instrument foundations will evaluate how best an SP can reach these goals. There are several scenarios that should be taken into consideration when constructing a plan of action.
●Performing inventory counts to determine if the department has enough trays needed per service will allow case carts to be completed and deter IUSS for same-day cases.
●Having enough experienced staff and leadership on the floor to delegate trays will help to complete the plan of zeroing out the shelves.
●Working hand in hand and staying in communication with the OR for the first and second cases of the next day will help to ensure efficiency and ease in the process.
Jhmeid Billingslea, the Managing Director of Surgical Services for Advantage Support Services, states that ***“there is a false flag argument, which argues that technicians should build as many terrible trays as possible, just as long as the quantity expectation is reached. In his experience as a Sterile Processing Director of over a five-campus hospital system, he stated that “the reality of productivity per technician is that the most productive technician has the lowest error rates and the highest error rates are from technicians that produce the least trays.” He also states that “the risk of leaving trays undone due to tray perfection is unacceptable. In reality, most trays will be completed, but not all trays by the end of the day.” The lack of having trays left over at the end of the day to be processed is the rationale for having established educated, experienced supervisors with full competencies.” Providing tools for technicians to successfully complete a quality tray takes dedication from the leader to provide oversight, a delegation of priority trays, availability of quality inspection tools, and lots of education.
Delegation of Priority Trays
SP Supervisors should be educated and informed. They should be permitted to delegate trays and access the OR schedule for today and the next day’s business. They should work strategically with the OR Board Runner and service line coordinators for each service on the schedule to ensure success. The supervisor and technicians should also oversee the quality produced in trays before the containers or wrapped trays are closed and prepared for sterilization.
Education is key. The processing technicians should not only be certified but should be able to implement the principles of sterilization in each task as they build them. They should also have the knowledge base for each surgical service, such as Ortho, Spine, Heart, etc.. Each tray should be made according to the count sheet while implementing quality assurance steps
Each technician has a level of expertise in a specific area, whether that be the service line or in knowing the correct process of completing trays. A time study for certain tray types should be performed per the technician’s experience level. For example, the Tech I level may have less than six months of experience; the Tech II level may have less than one and a half years of experience, and so on. Leaders should also consider if the technician has experience in your facility. They may have a year of knowledge, but if it is from another hospital and not acclimated to your facility, it could lessen their expertise for your specific customer needs.
To be successful, we must have productivity standards. Though there is no national standard, using a time study lessens quotas for all as a one-and-done approach. To remedy this, there should be expectations set per experience level and tray type.
In setting tray type time standards, there are many factors to consider. Are there more or less than 100 instruments? Is this an orthopedic vendor tray vs. a plastics or general case tray? A time study per tray type can be established by supervisors and educators who dedicate two weeks to this project, as they gather data to develop average times to assembly trays. Using instrument quizzes to identify can be provided to the technicians and help determine the technical expertise in a particular service. These tests can also choose the education action plan needed for specific technicians.
Time studies and the level of expertise per technician can help determine a leader’s expectations of each department employee. The expectations should not be set for all technicians at the same times. They are instead based on each specific technician's experience level, which can be used for goal setting as leaders perform yearly evaluations.
Quality versus quantity is an ongoing challenge. Yet, this is achievable if the department leaders invest the time to perform studies, evaluate technician performance levels according to their expertise and communicate with internal staff and external end-users. Collectively, these efforts will not only set standards for quality but also help ease the manufacturing mindset to focus on patient care.
*Healthcare Sterile Processing Association (HSPA) states in the (CHL)
**Infection prevention: 10 sterile processing benchmarks - outpatient surgery magazine - August 2019. Association of periOperative Registered Nurses. (n.d.). Retrieved August 2, 2022, from https://www.aorn.org/outpatient-surgery/articles/...
***Jhmeid Billingslea, Managing Director of Surgical Services, Advantage Support Services, Inc.